American Expeditionary Forces in World War I

American Expeditionary Forces in World War I A. Plan of Investigation This investigation assesses the significance of the American Expeditionary Forces to the United States victory in World War I. In order to asses this, the role of the American Expeditionary Forces is investigated during major battles of World War I. The success or failure of the American Expeditionary Forces at each battle is determined and evaluated for significance. Two of the sources used in this paper, I. The World War., and Americans as Warriors: Doughboys in Battle during the First World War. are evaluated for origin, purpose, value and limitation. This investigation does not assess the significance of other American Forces (U.S. Army Air Service and United States Navy) to the United States victory in World War I. B. Summary of Evidence The first American battle of World War I was the Battle of Cantigny, fought from May 27th, 1918 to May 31st, 1918. During this battle the 1st Division of the American Expeditionary Forces and French Army attacked the German held French village of Cantigny. Cantigny was taken by the American Expeditionary Forces and French Army on May 28th, 1918, marking the first successful battle of World War I for the American Expeditionary Forces. [1] Piper, Gayln Battle of Cantigny First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/battle_of_cantigny/default.aspx. [2] I. The World War. Political Science Quarterly, vol. 33, no. 3, 1918, pp. 1-27., www.jstor.org/stable/2141489. Pg. 22 Following the Battle of Cantigny, the Battle of Saint-Mihiel was fought from September 12th, 1918 to September 15th, 1918. After proving their combat ability at the Battle of Cantigny, the American Expeditionary Forces planned to overrun German held Saint-Mihiel with overwhelming force.   Under the American onslaught, German defenders gave way, preferring to give up ground and retreat in good order rather than fight. The German retreat marked another success for the American Expeditionary Forces. The Meuse-Argonne Offensive was the final Allied offensive of World War I. The battle was fought on the entire Western Front, lasting from September 26th, 1918 to November 11th, 1918. This battle marks the crowning achievement of the American Expeditionary Forces, after 47 days of fighting the German Empires armistice ended the battle. The American Expeditionary Forces won the war. C. Evaluation of Sources I. The World War published by Political Science Quarterly in 1918 is a record of political events from August 1, 1917 to July 31, 1918. This journal was written with the purpose to act as a factual news source, pulling information from newspapers, letters and interviews. [3] Manning, Mary St. Mihiel: A Push Forward First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/st_mihiel/default.aspx. [4] Manning, Mary St. Mihiel: A Push Forward First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/st_mihiel/default.aspx. [5] Keene, Jennifer D. Americans as Warriors: Doughboys in Battle during the First World War. OAH Magazine of History, vol. 17, no. 1, 2002, pp. 15-18., www.jstor.org/stable/25163558. Pg. 1 [6] I. The World War. Political Science Quarterly, vol. 33, no. 3, 1918, pp. 1-27., www.jstor.org/stable/2141489. Pg. 1 The journals value is that it provides unbiased information for the reader to consume, however the journal is limited because many war statistics were withheld from the public during World War I. Americans as Warriors: Doughboys in Battle during the First World War published by the Oxford University Press in 2002 is an article evaluating several key battles in the final year of   the war, including Cantigny, Belleau Wood, Chà ¢teau-Thierry, Soissons, St. Mihiel, and Meuse-Argonne. The article was written with the purpose of providing the reader information about the American Expeditionary Forces and their involvement in World War I battles. The articles value is that it provides an evaluation of major World War I events, however the article is limited because the evaluations are only from an American perspective. D. Analysis It is clear that the American Expeditionary Forces were critical to the success of the United States in World War I. Beginning with their first offense at the Battle of Cantigny the American Expeditionary Forces proved to be a powerful, well trained force. Cantigny made a profound statement to Germans and Allies, setting the stage for Allied success in the war. The Battle of Saint-Mihiel again proved the strength of the American Expeditionary Forces. The battle was won with only 7,000 American casualties, a very small loss [7] Keene, Jennifer D. Americans as Warriors: Doughboys in Battle during the First World War. OAH Magazine of History, vol. 17, no. 1, 2002, pp. 15-18., www.jstor.org/stable/25163558. Pg. 1 [8] Piper, Gayln Battle of Cantigny First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/battle_of_cantigny/default.aspx. [9] Manning, Mary St. Mihiel: A Push Forward First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/st_mihiel/default.aspx. by World War I standards.The battle provided an opportunity for the newly organized American units to work and fight together as an American army, gaining valuable experience they would need for the coming Meuse-Argonne offensive. The Meuse-Argonne Offensive was the most important battle fought by the American Expeditionary Forces, proving that they were the single most import force to the United States victory during World War I.   Nearly 1.2 million soldiers participated in the battlewithout a force of this size the Allies may have lost the battle and never gained German Armistice. The the American Expeditionary Forces is greatly responsible for the success of the Allies and the United States in World War I. E. Conclusion The American Expeditionary Forces were the most significant attribute to the United States victory in World War I. The American Military Forces were essential to the success of the Allies in many key battles of World War I, without the American Expeditionary Forces a German armistice may have never occurred. The American Military Forces were so significant to the United States victory in World War I, that they have become a symbol of patriotism and stability in America, paving the road for American success in future wars. [10] Manning, Mary St. Mihiel: A Push Forward First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/st_mihiel/default.aspx. [11] Keene, Jennifer D. Americans as Warriors: Doughboys in Battle during the First World War. OAH Magazine of History, vol. 17, no. 1, 2002, pp. 15-18., www.jstor.org/stable/25163558. Pg. 1 [12] Wingate, Jennifer. Over the Top: The Doughboy in World War I Memorials and Visual Culture. American Art, vol. 19, no. 2, 2005, pp. 26-47., www.jstor.org/stable/10.1086/444480.   Pg. 28 F. Bibliography Primary Sources: I. The World War. Political Science Quarterly, vol. 33, no. 3, 1918, pp. 1-27., www.jstor.org/stable/2141489. Front Matter. Political Science Quarterly, vol. 34, no. 3, 1919, pp. i-iv., www.jstor.org/stable/2141668. Secondary Sources: Keene, Jennifer D. Americans as Warriors: Doughboys in Battle during the First World War. OAH Magazine of History, vol. 17, no. 1, 2002, pp. 15-18., www.jstor.org/stable/25163558. Manning, Mary St. Mihiel: A Push Forward First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/st_mihiel/default.aspx. Piper, Gayln Battle of Cantigny First Division Museum at Cantigny. Web. Mar. 2016. http://www.firstdivisionmuseum.org/museum/online/toward_the_front/battle_of_cantigny/default.aspx. Wingate, Jennifer. Over the Top: The Doughboy in World War I Memorials and Visual Culture. American Art, vol. 19, no. 2, 2005, pp. 26-47., www.jstor.org/stable/10.1086/444480.

Workplace Injuries And Fatalities In The Uk Industry Construction Essay

Hazard is an of import factor which must see before get downing any sort of work either it is in any administration, place or related to any building, consideration of hazard is an of import portion of work, In this study all the parts are covered sing hazards consideration, analysis of hazard and so how to safe our work topographic point from these accidents, hurts and human deaths. There are different degree of hazards some are low degree hazard, which are less unsafe than other, but we besides start consideration from really low degree hazard to high degree hazard, from these consideration we are able to safe our full work topographic point with quiet efficient manner. This reports covers statistical tendencies of last five old ages for hurts and human deaths, prosecutions for failures to put on the line appraisals, it besides covers the benefits of hazard appraisal either it is effectual or non. It describes the linkage between the hazard appraisal and safety betterments. After completion of this study we are able to implement proper and accurate hazard appraisal in administration, which help us to cut down the hazard and better the overall efficiency of the industry. Injuries and human deaths are recorded daily in every sector of work. In the concern and corporate sector wellness and safety safeguard are implement for bar of accidents in the industries, nevertheless at some certain state of affairs they are fail to safe the employers which are working. These guidelines put under enormous strain to the employers. Such as enforcement of jurisprudence, direction of fire, building, public-service corporations, excavation, Injuries related in transit occupation, retail and nutrient service are non minimized. There are figure of hurts which may be go on during work, such as cut, break, sprain, amputation or other hurt that consequences an accident in work or exposure in the work environment, harmonizing to the council of national safety. Injuries at workplace should be reported harmonizing to the process of employer ‘s wellness and safety to enter the accident and to guarantee there is no hold in the first assistance or medicine attending. If there is fail to make so may ensue compensations publish provide to employers.Statisticss and Tendencies in UK Workplace Injuries and FatalitiesThese statistics cover which are related to work human deaths that are reportable under the Reporting of Injuries, Diseases & A ; Dangerous Occurrences Regulations 1995 ( RIDDOR ) , and are updated on a quarterly footing. A effect of supplying item that is updated as possible, there are many of instances are still in the probe. Therefore on the footing of probationary these statistics are available but it may be demand of alteration for more accurate information releases. In these statistics as they are reported under the some statute law, but some deceases are non included in this statute law. Some deceases are excluded from these statistics as they are reportable under other statute law. The chief exclusions are as follows: Accidents involved during the traveling of workers on main roads. Such as a route accident, accidents which are occurred during the worker traveling by air or ships in sea, are non covered by this statute law, these incidents are the duty of ACI subdivision and MAI subdivision, and cover harmonizing to their regulations. Fatal hurts at work due to ‘natural causes ‘ , normally bosom onslaughts or shots, unless brought on by injury due to the accident.Main industryAgricult-ureExtractive & A ; public-service corporation supplyManufacturingConstructionServicessAll IndustriesEmployees1706222935109Self employed21–02120742Workers*3806244142151Members of the populace0701–04381393Entire human deaths450724454235442.2.1. Numbers of fatal hurtsTable 1: fatal hurts Numbers by Sector for 2009/10This tabular array demo the information on the fatal hurts for last twelvemonth 01 April 2009 to 31 March 2010.2.2.2. Regional dislocationThis tabular array incorporate the informa tion of dislocation of the fatal hurts to worker regional wise.Government Office Region ( GOR )All IndustriesSouth West18South East14London11East8East Midlands13West Midlands10Yorkshire22North West19North East3Cymrus7Scotland23Not known3Entire151Table 2 – Numbers of fatal hurts to workers broken down by Government Office Region 2009/102.2.3. Injuries and Fatalities related to work in fabrication industriesThere are figure of accidents occurred in the fabrication industries, due to lake of staff and avoiding of safety regulations which used in industries for the safety of workers, In Britain work force, there are 9 % of fabrication histories but hurts reported 16 % , human deaths reported 21 % , major 15 % , 16 % is the norm of over three twenty-four hours inquires ) . Harmonizing to the study of LFS, 13 % hurts occurred are non fatal hurts in fabricating industries in 2008-2009. This is mean of last three old ages. There are besides reported hurts that involved contact with the machinery is about 160 instances in last twelvemonth, 24 % in the fabrication industries affecting detonations, 21 % , hit by traveling points, falling material, or fire and 19 % injured with the harmful things. Within Manufacturing, the bomber group recycling has a rate of reported major hurt over five times the rate for Manufacturing as a whole, while Wood & A ; Wood Products has about twice the rate ; each histories for about 4-5 % of reported major hurts in fabrication. In the nutrient Merchandises, drinks and Fabricated Metal Products have major incidents rates of 1.5 times that for all Manufacturing, but together history for 39 % of reported major hurts. The rate of fatal hurts has fallen since 1981 by over 57 % and by 15 % since 2000-2001, but this still means that 400 workers suffer hurts between 2000 and 20009-2010- 2096 since 1981. There have been similar decreases in major and over three twenty-four hours rates of 16 % and 37 % severally, since 2000/01 and 49 % in the LFS rates of hurt from 2000/01 to 2008/09.The estimated prevalence rate of self-reported work-related ailment wellness in 2009/10 was between 3A 000 per 100A 000 people ( 3.0 % ) working in the last 12 months, harmonizing to the Labour Force Survey ( LFS ) . The incidence rate of reportable non-fatal hurt was 970 per 100A 000 workers ( 0.97 % ) in 2008/09 ( three-year norm ) , based on the LFS. In 2009/10, the LFS showed that 2.4 million on the job yearss ( full-day equivalent ) were lost in this industry due to workplace hurt and work-related ailment wellness.3.0. Hazard AppraisalHazard appraisal is a procedure which is a portion of hazard direction, it assign comparative things which must be consider in planning and nidation of procedures.3.1. Background and overview:In modern epoch, everyplace increases the usage of modern equipments, engineer ings and developed information, and every one trust on these digital material. It can back up in our educational, research and development, disposal and industrial environment, although these engineerings and dependable and on other manus it increase the degree of duty to protect the assets of information from any sort of harm or accidents. Risk direction is the uninterrupted procedure from which we can place or noticed these sort of hazard and program which can be implementing to turn to them. It is really of import to understand and pull off decently, it gives us information that where to use these resources which are available. It helps us to extenuate hazard is control, effectual and efficient manner, it besides help us to cut down the cost and do it profitable There are following points which are of import to see. It should be thought of as an uninterrupted procedure, non as a one clip procedure, stairss are defined before the execution, it may be repeated, nevertheless it normally non repeated start up procedure. It must be coaction between the cross functional units, university carry oning a broad information hazard appraisal is a procedure which require relationship and strong committedness from higher disposal to local staff. The connexion is more of import in the appraisal. An effectual university information hazard appraisal needs to go a portion of the civilization of the university community, affecting non merely IT-staff but besides all staff, decision makers, module, and pupils. Education and consciousness attempts should be aimed at all of these constituenciesStairss involved in Risk Assessment1. Measure the possible impact of menaces to critical assets ( qualitative and/or quantitative ) 2. Measure the likeliness of happening of the menaces ( high, medium, low ) 3. Make a amalgamate analysis of hazards, based on the impact value to critical assets and the likeliness of happeningHazard Assessment in the Mining IndustryIn excavation industry there are assorted sort of hazards are involved, to avoid those hazards, we must implement the hazard appraisal procedure, for the appraisal there are five stairss are involved to place the hazards which help to protect workers and increase the efficiency of industry, there are five stairss are involved to buttockss, such as identify the jeopardies, than make up one's mind which 1 is harmed and how, measure the hazard and happen safeguards of that hazard, enter your determination and implement them and eventually you must reexamine your appraisal if update is require or non. Hazards and jeopardies come in many formats at a mine site: confined infinites, electrical, legal conformity, audit, mechanical, chemical, regulative conformity, force per unit area ( air, H2O, and gases ) , site security, noise, thermic, radiation, organic structure mechanics, biological and the ever-present force of gravitation. All of these must be understood and managed on a proactive footing to guarantee zero injury and sustainable development. Whether you ‘re the site GM or a functional overseer, understanding and pull offing hazards across your concern thrusts production, ensures the safety of your work force and lowers your costs. Guaranting your concern standardizes the ways it identifies and analyses hazards is a nucleus constituent of effectual hazard direction. Additionally, being able to drive duty and answerability for hazards across the site guarantee all hazards are suitably direction and mitigated.4.0. Hazard Assessment and Safety ImprovementsTo better the well ness safety system in any industry is a duty of direction that it must be after and implement a proper system of hazard appraisal and safety steps, These safety steps are aid to confront any accident which occur in the industry and prevent workers and machinery which is installed, For better hazard appraisal need proper be aftering. There are figure of stairss are involved to forestall or get the better of the hazards which may be bring forth during the procedure. It should cover all operations which are in the industries, such as cleansing and care activities, it may be reflect. The undermentioned diagram show the stairss of hazard appraisal. The diagram indicates where hazard appraisal tantrums within an administration and the assorted inputs and end products that surround this procedure. It should be clear that hazard appraisal is non an terminal in itself, but simply portion of a procedure to assist guarantee a safe and healthy workplace. Safety is one of the really of import portion of any organisation, without safety none of any concern met the challenges of the market, for the better processing or production the direction must implement the safeguard step for the employer safety, it increase the efficiency of the organisation and do net income. Environment become safe and healthy and employers work freely without taken any emphasis on head sing accidents incidents. Figure: Hazard Assessment in Organisation5.0. Reappraisals of AppraisalThe result of appraisal of hazard should be addressed harmonizing to the administration ‘s hazard direction policy and processs. The execution squad should reexamine the recommendations from the appraisal of planning and treatments, and agree whether to implement these appraisals of hazard as they stand or to modify these appraisals. The squad will besides necessitate to hold how they should be implemented. The identified jeopardies and the in agreement actions need to be placed either on the administration ‘s, or patterns, local hazard registry. After item reviews the squad decided to implement hazard appraisal in any administration to avoid accidents and jeopardies which are produced during the procedures. The squad responsible for behavior all safeguards which are necessary for the safety of employers which are working in these industries. They prepare a study for the all impacts and reappraisal in item than discuss with the direction after that they are eventually travel for the execution of hazard appraisal in the house.6.0. Document Control in Risk AssessmentThe purpose of papers control policy in the Risk Assessment is to guarantee all hazards are Identified and assessed decently and take safeguards to cut down the effects of hazards and safe the environment in administrations, A appraisal of hazard is depend on the different sort of signifiers which should be completed with information which is recorded in administration every bit much as possible. These signifiers will be used to put on the line come in the registry and after its completion the registry should send on to section of hazard. There are many parts of the signifier administration should clearly specified in the signifier. Name of individuals lending to the appraisal of hazard. Manager of the section is included in this exercising. A description of the hazard and the hazard evaluation or hazard mark, utilizing the likeliness and badness charts. A record of what is already in topographic point to command the hazard, or has been put in topographic point instantly. Actions which are necessary to further cut down the hazard. These actions need to be realistic and accomplishable. Date when hazard and action program will be reviewed, on the footing that the recommended action is implemented.Decision And RecommendationTo sum up all the facets of hazard appraisal, I conclude that nowadays there are different attacks can take for the analysis of hazard. It can be quantitative i.e. it can delegate figure of numeral values of chances and effects, qualitative or combination of two. A determination made against the analysis of hazard is really hard undertaking but by the execution of hazard appraisal tools is really easy to place and assesses the hazard in the industry. From the value of hazards predicted, helps us to implement hazard appraisal tool in the administration. The import thing is differentiation when it comes to using analysis of finance to determinations and their precedences. Analysis of Quantitative hazard is really expensive, bing up to ten times every bit much as qualitative analysis. Wide usage of hazard analysis tools in industries are progressively, there are figure of analysis which are soon increase quickly are fault tree analysis or failure manners and consequence analysis, to cut costs and to better dependability and safety. This study covers all the impacts and their appraisals in industries, it besides cover the last five twelvemonth tendencies for hurts and human deaths. This study helps us to how to implement the proper and exact hazard appraisal analysis in the industry.

Centers for Medicare and Medicaid Services (CMS) Essay

Procedure Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be anchored for many unnecessary days and in some cases until discharge. In 2008 the Centers for Medicare and Medicaid Services (CMS) initiated a policy change to no longer reimburse hospitals for additional cost that were incurred due to catheter associated urinary tract infections or in another term CAUT’Is (Palmer, 2013). The CMS recognized that CAUTI’s are the most common type of hospital acquired infection. The CMS also determined that when evidence based practices are initiated and followed they can be highly preventable, leading to a change in practice. Current Practice Up until 2012 there were no policies pertaining to the anchoring or removal of indwelling catheters in the facility I work for. Nursing would complete their assessment of the patients and per their discretion they would determine if an indwelling catheter by their standards is appropriate. An indwelling catheter could be deemed appropriate according to nursing for multiple reasons including; urinary incontinence, retention, convenience, pressure ulcers, strict output recordings and in some cases per patient request. The nurse was required to obtain an order from the physician in order to anchor a catheter and most cases the physician would comply. After the nurse anchored a catheter it would most likely stay anchored until discharge or until and order was given by the physician to discontinue it.  These procedures lead to the unnecessary length of times catheters were kept in place and the need for change. Rational and Explanation Even though in 2008 Medicare and Medicaid changed their reimbursement policies it wasn’t unit 2012 when the Joint Commission added guidelines for the prevention of CAUTI’s and the facility I work for initiated change. Prior to the Joint Commission’s new guidelines management relied on nursing to make the proper decisions for their patients and supported nursing when they deemed it necessary to anchor a catheter. In 2012 when the guidelines were initiated management chose to follow them when evidence based research supported CAUTI’s were preventable when the appropriate protocols were followed. Hospital management initiated evidence based practices that were supported by CMS and the Joint Commission that would assist nursing on when anchoring a catheter was necessary. The team responsible for these changes included the clinical manager in charge of all medical surgical units, each medical surgical unit manager where these changes were to take place and the medical surgical educator. This team reviewed evidence based research and practices on how to improve CAUTI’s and thru this research came up with a plan to implement nurse driven protocols that would be beneficial to our facility. These protocols instructed nursing, thru protocols on the patient’s EMR to guide nursing when anchoring a catheter would be appropriated and it also gave nursing the ability to remove a catheter when it was deemed unnecessary. After the protocols were initiated management began to notice a decrease in the use of catheters and a decrease in CAUTI’s resulting in cost effectiveness and higher patient satisfaction scores for the hospital. References Bernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 32 (1): 29-37. Carter, Nina M, Reitmeier, Laura, Goodloe, Lauren R. (2014). An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infection. Urologic Nursing, 34 (5): 238-45. Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary track infection in adults: 2009 international clinical practice guidelinges from the infectious diseases society of America. Clinical Infectious Diseases, 50(March): 625-663. Knoll, Bettina M.; Wright, Deborah; Ellingson, LeAnn; Kraemer, Linda; Patire, Ronald; Kuskowski, Michael A.; Johnson, James R. (2011). Reduction of Inappropriate Urinary Catheter Use at a Veterans Affairs Hospital Through a Multifaceted Quality Improvement Project. Clinical Infectious Diseases. Vol. 52 Issue 11, 1283-1290. DOI: 10.1093/cid/cir188. Mori, C. (2014). A-Voiding Catastrophe: Implementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28. Clinical Implications An implemented change that would reduce the rates of CAUTI’s in acute health care facilities would be evidence based nurse lead protocols. The protocols would not only benefit the hospitals but they would also contribute to patient satisfaction scores. Approximately 80% of all nosocomial infections are contributed to CAUTI’s and are the most common form of nosocomial infections (Knoll, 2011). Some of the symptoms that contribute to the patients discomfort include hematuria, flank pain, fever and in some cases altered mental status. After a patient develops a CAUTI the patient receives the recommended treatment of antibiotic therapy. Antibiotic therapy could last up to 7 days which could result in an increase of stay (Hooton et al., 2010). Evidence supports that when nurse led or informatics led interventions are implemented CAUTI’s were decreased (Bernard, 2012). The interventions that assist in the prevention of  CAUTI’s are protocol bundles that include insertion policies, removal policies, maintenance policies and competency training (Carter, 2014). If the proper prevention measures are implemented patient satisfaction scores would improve, infection rates would improve leading to a decrease infection rate and shortening patient’s length of stay. Recommended Changes If the prevention protocols that are listed above were implemented changes would occur that would lead to multiple benefits for both the acute care facilities and the patients. Extended hospital days due to CAUTI’s has added to approximately 90,000 days per year and due to Medicaid and Medicare no longer paying the associated cost for CAUTI’s the hospitals out of pocket expenses are estimated at approximately 424 million dollars per year (Mori, 2014). The changes that are discussed and supported in this research paper would have a positive impact on decreasing this data. If the protocols are implemented not only would they benefit the patient’s but they would also benefit the hospitals. Patients would have a decrease risk in acquiring nosocomial infections and hospitals would have the opportunity to use the millions they are losing to benefit the patients. The hospitals could apply the money they are losing for research and/or other areas to improve overall satis faction, increasing hospital census. Stakeholders The stakeholders in implementing this change at the facility I work for would be the unit managers and the nurse educators in the units where these changes would take place. For the unit managers the increased costs that are acquired due to CAUTI’s would have a direct impact on them along with the patient’s overall satisfaction scores. The evidence based research that would be implemented would be presented to the unit managers and the nurse educators. The unit mangers would be the ones to determine if and when the new protocols would take effect. The nurse educators would be the ones educating staff on the new protocols and would be a vital part of evaluating the protocols along with suggesting and implementing changes if necessary. Change would happen in stages with the first stage being the unfreezing stage. This stage occurs when stakeholders receive the information on a change along with supporting evidence to why the change would be beneficial. The second step would be the moving stage. This is the stage when goals  and dates are set to when the change is to take place. The refreezing stage is the last stage. The refreezing stage is when the change is implemented and becomes hospital protocol. The end stage is when the nursing staff would need the most support until the change becomes the hospitals new standard (Cherry & Jacob, 2010). The steps listed will assist getting everyone on board with the change and complying with it. Barriers Anytime when new protocols or procedures are implemented barriers may occur. Not everyone is open to change and many may have a hard time adjusting. Many nurses have been following the same policies and procedures for many years and may be noncompliant due to habit. Another barrier may be the patients, â€Å"frequent fliers† or patients that frequent the hospital regularly have become accustomed to old protocols and may not be receptive to change. The frequent fliers are used to coming in and requesting catheters so they don’t have to get up to the bathroom or if they have incontinency issues. Management and the educators will have to work diligently with nursing to initiate change and nursing may have a difficult time adjusting to the change along with educating patients and enforcing the protocols. Strategies Strategies to overcome the barriers of change would include using Lewin’s Change Theory. This theory suggests that change should be initiated slowly and making the necessary changes with only the staff that would be involved (Cherry & Jacob, 2010). Management and the nursing educator should provide staff with the evidence based research as to why the change is being made so nursing can understand why the change is necessary. By following these strategies nursing may be more compliant with the change and can be better advocates for the patients. Application of Findings CDC guidelines recommend catheters to be inserted for necessary reasons which include urinary retention, strict intake and output, certain surgical procedures, healing for pressure ulcers in incontinent patients and in palliative care patients (Gray, 2010). As research has provided indwelling catheters should be placed only when deemed necessary and removed when they are unnecessary. The facility I work for along with quality control  and the nursing educator put together CAUTI prevention strategies using evidence based research practices. Protocols were initiated in the patient’s electronic medical record (EMR) that would assist nursing in making the right decision whether to cath or not and when it would be appropriate to remove an indwelling catheter. The charge nurses monitor the number of catheters each unit has and researches if they are deemed appropriate to keep anchored. All of these measures have decreased the occurrences of CAUTI’s in the facility I work for. Continued monitoring by quality control is still needed to insure assessments are completed properly and to monitor if the measure the protocols are working. References Bernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 32 (1): 29-37. Carter, Nina M, Reitmeier, Laura, Goodloe, Lauren R. (2014). An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infection. Urologic Nursing, 34 (5): 238-45. Cherry, B., & Jacob, S. (2010). Contemporary Nursing: Issues, Trends, and Management. (5th ed.) St. Louis, MO: Mosby Elsevier. Gray, M. (2010). Reducing catheter associated urinary tract infection in the critical care unit. AACN Advanced Critical Care, 20(3), 247-257. Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary track infection in adults: 2009 international clinical practice guidelinges from the infectious diseases society of America. Clinical Infectious Diseases, 50(March): 625-663. Knoll, Bettina M.; Wright, Deborah; Ellingson, LeAnn; Kraemer, Linda; Patire, Ronald; Kuskowski, Michael A.; Johnson, James R. (2011). Reduction of Inappropriate Urinary Catheter Use at a Veterans Affairs Hospital Through a Multifaceted Quality Improvement Project. Clinical Infectious Diseases. Vol. 52 Issue 11, 1283-1290. DOI: 10.1093/cid/cir188. Mori, C. (2014). A-Voiding Catastrophe: Implementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28.

The Use of Laughter as Medicine in Ken Keseys One Flew...

The Use of Laughter as Medicine in Ken Keseys One Flew Over the Cuckoos Nest For years, it has been said that laughter is the best medicine. In Proverbs 17:22 it says, A merry heart doeth good like a medicine. Imagine being in a place where medicine takes the place of laughter. This is the environment the patients at an Oregon psychiatric hospital in Ken Keseys One Flew Over the Cuckoos Nest (1962) experienced before the arrival of a new patient. Chief Bromden, who is presumably deaf and dumb, narrates the story in third person. Mr. McMurphy enters the ward all smiles and hearty laughter as his own personal medicine. One Flew Over the Cuckoos Nest is a story about patients in a psychiatric hospital, who are under the power†¦show more content†¦Nurse Ratched says, Does anyone care to touch upon this subject further? (44). McMurphy acts mislead about what Mrs. Ratched has asked and asks back, You ask, I believe, Does anyone care to touch upon--- (44). Mrs. Ratched snaps back at McMurphys response with, Touch upon the---subject, Mr. McMurry, the subject of Mr. Hardings problem with his wife (44). McMurphy uses despaired ideas to respond in this. McMurphy tries to make a joke at the fact that Hardings wife makes him, Harding, feel inferior because of her large breasts, because he doesnt want to bethink Hardings problem. When Mrs. Ratched posts work assignments, she assigns McMurphy the latrine. He thinks it would be appropriate to thank her personally for the honor. The only work that was done to the toilets was a brush ran along the bowls once or twice apiece and some Clorox splashed around inside of them. After he finished, he said, Thats clean enough. Maybe not for some people, but myself I plan to piss in em, not eat lunch out of em (138). Nurse Ratched went to inspect McMurphys work and exclaimed, Why, this is an outrage...an outrage... (138) at every bowl she saw. McMurphy replied, No; thats a toilet bowl...a toilet bowl (138). Through this exclamation Mr. McMurphy makes fun of Mrs. Ratcheds choice of words to get over the fact that he did, indeed, do a bad job on the toilets. After McMurphys crazy fishing trip, Chief Bromden and